Medicaid to reimburse cochlear device separately from outpatient implantation

 IHCP to reimburse cochlear device separately from outpatient implantation Effective October 4, 2018, the Indiana Health Coverage Programs (IHCP) will reimburse the cost of Healthcare Common Procedure Coding System (HCPCS) code L8614 – Cochlear device, includes all internal and external components separately from the cochlear implant procedure, when the implantation is performed in the outpatient surgical setting. Separate reimbursement for this device is subject to IHCP coverage policies. 

This change applies to services rendered under the fee-for-service (FFS) and managed care delivery systems for dates of service (DOS) on or after October 4, 2018. 

Beginning October 4, 2018, facility providers may submit claims for separate reimbursement for L8614 on a CMS-1500 professional claim form or its electronic equivalent. The device is priced with a maximum fee rate. Prior authorization (PA) is not required for the device, however PA for implantation continues to be required as is current IHCP policy. The reimbursement changes for L8614 will be reflected in the next regular update to the Outpatient Fee Schedule at indianamedicaid.com. Some exceptions to outpatient pricing apply to Healthy Indiana Plan (HIP) services; providers should contact the enrolling managed care entity (MCE) for outpatient pricing for HIP members. PA requirements apply to services delivered under the FFS delivery system. Individual MCEs establish and publish PA information within the managed care delivery system. Questions about PA for managed care members should be directed to the MCE with which the member is enrolled. 

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